The Objective of theses Blogs -created by Prof.Garfia.A- is show the most representative and illustrative cases which I have found during 25 years of experience in the field of the Forensic Pathology in Spain, in order to use this experience to the service of the younger people who wish to obtain a Medical Degree in Forensic Pathology.Also I intend that this information can be useful to the professional people who are working, daily, to the Justice Service in Spain.

Bleeding occurs either into brain substance (brain haemorrhage) or into the subarachnoid space (subarachnoid haemorrhage).

The commonest causes of non-traumatic subarachnoid haemorhage (spontaneous haemorrhage) are, in this order: 1) rupture of saccular aneurysm (65%) 2) arteriovenous malformation rupture (5%) and 3) extension of intracerebral haematoma usually into ventricles and then into the subarachnoid space ( 5%)..About 90% of saccular aneurisms are located in distributions of the internal carotid arteries; the remaining 10% are located on the vertebrobasilar arterial tree. Multiple aneurysms are found in 10-15% of patiens with subarachnoid haemorrhage; these are said to be associated with:

1.- Coarctation of the aorta.

2.- Renal artery stenosis.

3.- Autosomal Dominant Adult Polycystic Kidney Disease ( AD-PCD).

The possible common denominator for the formation of saccular aneurysms is arterial hypertension; however, in AD-PCD there are mutations affecting three genes: PKD1 ( linkage to chromosome 16: 85% of cases); PKD 2 ( 10% of families) and PKD 3. Two of these three genes encode for protein named Policystin I and Policystin II which have an important function in interactions between cells, and between the cells and the extracellular matrix. Abnormal proteins encoded in AD-PCD can play an important role in the origen of saccular aneurysms and in the formation of renal cysts.

In this report it is presented a case of Sudden Unexpected Death due to a Fatal Subarachnoid Haemorrage.The autopsy demonstrates the existence of a AD-PCD and multiple saccular aneurysms in the vertebro-basilar arterial tree -from one of these originated the fatal haemorrhage- and also a Hipertensive Cardiomyopathy (Heart:770g, with biventricular hypertrophy) unknown for the woman and for the family.